The economic costs of a multisectoral nutrition programme implemented through a credit platform in Bangladesh

Incremental financial costs of strengthening large-scale child nutrition programs in Bangladesh, Ethiopia, and Vietnam: retrospective expenditure analysis

BACKGROUND

Inattention to young child growth and development in a transitioning global environment can undermine the foundation of human capital and future progress. Diets that provide adequate energy and nutrients are critical for children's physical and cognitive development from 6 to 23.9 months of age and beyond. Still, over 70% of young children do not receive foods with sufficient nutrition particularly in low-and-middle income countries. Program evaluations have documented the effectiveness of large-scale behavior change interventions to improve children's diets, but the budgetary implications of programs are not known. This paper provides the incremental financial costs of strengthening three large-scale programs based on expenditure records from Bangladesh, Ethiopia, and Vietnam.

RESULTS

The programs reached between one and 2.5 million mothers and children annually per country at unit costs of between $0.9 to $1.6 per mother and child reached. An additional 0.7 to 1.6 million people who were influential in supporting mothers and achieving scale were also engaged. The largest cost component was counselling of mothers. Rigorous external impact evaluations showed that over 434,500 children benefited annually from consuming a minimum acceptable diet in all countries combined, at an annual cost per country of $6.3 to $34.7 per child benefited.

CONCLUSIONS

Large scale programs to improve young children's nutrition can be affordable for low- and middle-income countries. The study provides the incremental costs of selectively strengthening key program components in diverse settings with lessons for future budgeting. The costs of treating a malnourished child are several-fold higher than prevention through improved improving young children's dietary practices. Differences across countries in program models, coverage, costs, and outcomes suggest that countries need a minimum investment of resources for strengthening high-reach service delivery and communication channels and engaging relevant behavioral levers and community support for mothers to achieve impact at scale.

The Costs of a Multisectoral Nutrition Program Implemented Through a Poultry Value Chain Platform in Burkina Faso

Undernutrition in women and young children in Burkina Faso is a critical problem. Egg consumption is low despite many households raising poultry. The Soutenir l'Exploitation Familiale pour Lancer l'Élevage des Volailles et Valoriser l'Économie Rurale (SELEVER) project, an integrated agriculture-nutrition intervention, promoted egg consumption and sales to investigate the impact of poultry production on child nutrition. Multisectoral nutrition-sensitive agriculture programs address nutrition deficits but lack comparable cost information. This study estimates the costs of the SELEVER program, an integrated poultry and nutrition intervention. The study estimates the program's economic costs using a standardized methodology from the Strengthening Economic Evaluation for Multisectoral Strategies for Nutrition (SEEMS-Nutrition) consortium, which aligns financial and economic costs along program impact pathways, allocating costs by activities and inputs. We conducted qualitative interviews and focus groups on time allocation and beneficiary out-of-pocket costs. Incremental economic costs were calculated by combining expenditures and economic costs. The total incremental program cost was USD$18,084,727.68 over 5 years, with annual incremental costs of USD$209.20 per direct beneficiary and $796.26 per household. Major cost drivers included overhead (18%), poultry extension (17%), training (16%), household counseling (7%), technical assistance (7%) and microcredit (6%). Total input costs were dominated by personnel (51%), supplies (13%), agricultural inputs (10%) and overhead (9%). We present the total incremental costs of a multisectoral nutrition intervention to generate revenue with poultry. The costs per beneficiary were higher than similar interventions, underscoring the need for cost-effectiveness evaluations of multisectoral nutrition programs. A standardized cost methodology facilitates comparisons with multisectoral nutrition interventions and builds the evidence base.

Food Systems Interventions for Nutrition: Lessons from 6 Program Evaluations in Africa and South Asia

Although there is growing global momentum behind food systems strategies to improve planetary and human health-including nutrition-there is limited evidence of what types of food systems interventions work. Evaluating these types of interventions is challenging due to their complex and dynamic nature and lack of fit with standard evaluation methods. In this article, we draw on a portfolio of 6 evaluations of food systems interventions in Africa and South Asia that were intended to improve nutrition. We identify key methodological challenges and formulate recommendations to improve the quality of such studies. We highlight 5 challenges: a lack of evidence base to justify the intervention, the dynamic and multifaceted nature of the interventions, addressing attribution, collecting or accessing accurate and timely data, and defining and measuring appropriate outcomes. In addition to more specific guidance, we identify 6 cross-cutting recommendations, including a need to use multiple and diverse methods and flexible designs. We also note that these evaluation challenges present opportunities to develop new methods and highlight several specific needs in this space.

The costs of Suaahara II, a complex scaled-up multisectoral nutrition programme in Nepal

Limited evidence exists on the costs of scaled-up multisectoral nutrition programmes. Such evidence is crucial to assess intervention value and affordability. Evidence is also lacking on the opportunity costs of implementers and participants engaging in community-level interventions. We help to fill this gap by estimating the full financial and economic costs of the United States Agency for International Development-funded Suaahara II (SII) programme, a scaled-up multisectoral nutrition programme in Nepal (2016-2023). We applied a standardized mixed methods costing approach to estimate total and unit costs over a 3.7-year implementation period. Financial expenditure data from national and subnational levels were combined with economic cost estimates assessed using in-depth interviews and focus group discussions with staff, volunteers, community members, and government partners in four representative districts. The average annual total cost was US$908,948 per district, with economic costs accounting for 47% of the costs. The annual unit cost was US$132 per programme participant (mother in the 1000-day period between conception and a child's second birthday) reached. Annual costs ranged from US$152 (mountains) to US$118 (plains) per programme participant. Personnel (63%) were the largest input cost driver, followed by supplies (11%). Community events (29%) and household counselling visits (17%) were the largest activity cost drivers. Volunteer cadres contributed significant time to the programme, with female community health volunteers spending a substantial amount of time (27 h per month) on SII activities. Multisectoral nutrition programmes can be costly, especially when taking into consideration volunteer and participant opportunity costs. This study provides much-needed evidence of the costs of scaled-up multisectoral nutrition programmes for future comparison against benefits.